AHIP fraud waste & abuse questions and
answers already passed
Which of the following requires intent to obtain payment and the knowledge that the actions are
wrong? ✔✔Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? ✔✔Deportation
A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular
customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have concerns
about the possible forgery. What is your next step? ✔✔Call the prescriber to verify the quantity
Your job is to submit risk diagnosis to the centers for Medicare & medicaid services (cms) for
the purpose of payment. As part of this job you verify, through a certain process, that the data is
accurate. Your immediate supervisor tells you to ignore the sponsors process and to adjust/add
risk diagnosis codes for certain individuals. What should you do? ✔✔Report the incident to the
compliance department (via compliance hotline or other mechanism)
answers already passed
Which of the following requires intent to obtain payment and the knowledge that the actions are
wrong? ✔✔Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? ✔✔Deportation
A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular
customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have concerns
about the possible forgery. What is your next step? ✔✔Call the prescriber to verify the quantity
Your job is to submit risk diagnosis to the centers for Medicare & medicaid services (cms) for
the purpose of payment. As part of this job you verify, through a certain process, that the data is
accurate. Your immediate supervisor tells you to ignore the sponsors process and to adjust/add
risk diagnosis codes for certain individuals. What should you do? ✔✔Report the incident to the
compliance department (via compliance hotline or other mechanism)
